Dingell to retire – CMS report: Small business premiums rising – Medicare Advantage cuts maybe not so bad after all

By Paige Winfield Cunningham

02/25/14 10:00 AM EST

With help from Kyle Cheney and Brett Norman

REPORT: SMALL BIZ PREMIUMS RISING — Health insurance premiums of 11 million small-business employees will tick up under the health law, a new report quietly issued by the Obama administration says. Republicans drew attention to the findings yesterday, saying it’s more evidence that Obamacare is inflicting damage on workers. The report also found that premiums are expected to fall for the other 6 million small-business employees and the impact on premiums in large employer plans will be “negligible.” http://politico.pro/1bGWaEU

Story Continued Below

GOODBYE DINGELL, HELLO…? — The “Babe Ruth” of legislators — otherwise known as Rep. John Dingell (D-Mich.)—announced yesterday that he’ll be leaving Congress at the end of the year. POLITICO’s David Nather offers a career look-back at the man who introduced a universal health care bill in every new session of Congress and helped pass Medicare, the Affordable Care Act and just about every major piece of health legislation in between. http://politi.co/MW3IbH His retirement clears the field for a two-way contest between Reps. Frank Pallone and Anna Eshoo for the top Democratic spot on the Energy and Commerce Committee. http://politico.pro/MpJ42Q

It’s Tuesday. Welcome to PULSE, where I forgot to mention that I met up with Chris Christie over the weekend. If “met up” means colliding with him in the lobby of the Willard. Odd, but he didn’t seem interested in joining me for drinks. If only he’d known I planned to ask him about reconsidering a state-run exchange and not about the bridge scandal. C’est la vie.

“Funny how you broke me up, you made the PULSE now you drink the cup.”

SBA LIST FILES BRIEF TO SCOTUS — The anti-abortion group Susan B. Anthony List filed its arguments to the Supreme Court yesterday for a case the justices have agreed to hear April 22. It’s over 2010 ads by the group accusing former Democratic Rep. Steven Driehaus of voting for taxpayer-funded abortion — a charge Driehaus said was false under a statute barring lies in some political speech. That prompted SBA List to file suit against the state statute on First Amendment grounds. The lawsuit has the support of the ACLU of Ohio. The brief: http://bit.ly/1eclDFL

GOVERNORS NOTES — The National Governors Association wrapped up its four-day winter meeting yesterday and our colleague Kyle Cheney was there to catch all sorts of interesting nuggets. His front-line dispatches:

-- Democratic governors made it clear that they need more help from the White House in making the law work and selling it to voters. Missouri Gov. Jay Nixon told the president at a closed-door meeting that he should do more to play up health care innovations at the state level. Asked if the White House had done enough to win over the public to the ACA, Massachusetts Gov. Deval Patrick replied: “The short answer is no.” http://politico.pro/1fkuTmH

-- Patrick also criticized his rival, Republican Charlie Baker, who lost to Patrick in 2010, is running again and recently called on the White House to exempt the state from the health law. “It’s a very inauthentic message because there isn’t the opportunity to waive the ACA … a wholesale opting out of the ACA is not legally possible” Patrick told Kyle. A Baker spokesperson fired back, saying Baker “will not stop trying to protect the Massachusetts health care system just because some say it is too hard to do.”

-- Arkansas Gov. Mike Beebe doesn’t think Bentonville, Ark.-based Walmart should follow CVS’s lead and pull tobacco products from its shelves. If the company did follow suit, he said, other retailers would just get their business. “That’s their business decision they want to make, I don’t think it changes everybody’s attitude whether they quit selling cigarettes or not,” he said. Beebe also said his Republican-controlled legislature will likely embrace a state-run exchange over the next two years.

--Arkansas is inspirational to many Republican governors, who are working toward a similar path to Medicaid expansion that provides a “private option” where federal Medicaid funds are used to buy private insurance. Since Beebe signed Arkansas’ bipartisan deal into law last year, 100,000 people have signed up. The Pro story: http://politico.pro/1gxEIQz

** A message from AHCA. Skilled nursing has been tasked with a challenge: continue to improve quality care for millions of Americans and do so on razor-thin 1.8 percent margins. Even still, the long term and post-acute care profession continues to improve lives by delivering solutions for quality care. We are AHCA. And we are the solution. Learn more at ahcancal.org/solutions.

MA PAY NOT SO BAD AFTER ALL? – After the dust settled from the proposed Medicare Advantage pay notice last week, big insurer stocks actually ticked up on Monday. Humana climbed more than 10 percent and others saw smaller gains. At first blush the news had looked grave for insurers due to lower-than-expected growth rates, but the outlook got rosier as analysts found that CMS had made some behind-the-scene tweaks to risk adjustment and other factors that largely offset the sharply negative growth figures.

… Insurance industry analysts estimate that the proposed pay rates would cut MA plans between 4 percent and 9-plus percent this year, according to a snapshot of reports circulated by AHIP on Monday. That includes the ACA provisions on MA and an expiring bonus demonstration project that has boosted payments. The trade group is still complaining of potential “disruption” for 15 million seniors.

… But some experts pushed back against the complaints. Edwin Park with the liberal Center on Budget and Policy Priorities wrote that keeping the MA payment rates flat — as AHIP wants to do—“would effectively mean repealing or scaling back most provisions of health reform that rein in excessive Medicare Advantage payments over time.” He says the proposed cuts are sound. Park’s post: http://bit.ly/1hMbMK8

NUTRITION LABELS AWAIT MAJOR OVERHAUL — Should a regular bag of Chex Mix be labeled as containing eight servings or just two? Should pasta sauce jars tell how much sugar was added? The Obama administration is expected to take a major step toward addressing questions like these on Thursday when it unveils the first update to nutrition labels on food packages in more than two decades. Pro Agriculture’s Helena Bottemiller Evich reports: http://politico.pro/1jvfGUY

OBAMA ON THE PHONE — On a conference call yesterday, the president urged state and local officials and community leaders to take part in an “enrollment day of action,” the White House said. Sebelius also participated.

PREGNANT WOMEN: HOSTS? — Advocates for legal abortion are upset about the way a Virginia state lawmaker described pregnant women on Facebook. Sen. Steve Martin referred to a pregnant woman as “the child’s host” in a post explaining his opposition to abortion, but the phrase was later switched to “the bearer of the child.” Abortion rights activists slammed him on Twitter, saying pregnant women are “people,” not “hosts.” http://politi.co/1equi2P

ADS FOR NEBRASKA MEDICAID EXPANSION — The liberal advocacy group Americans United for Change is running radio ads in Nebraska calling on state lawmakers to expand Medicaid. The group believes that out of all Republican-led states, Nebraska currently has the best shot at flipping on the issue partly due to its non-partisan legislature, spokesman Jeremy Funk said. A committee approved an expansion bill on Monday and the full legislature is expected to take it up soon. Some of the ads: http://bit.ly/1bHgxSu and http://bit.ly/1c2ENyP.

SHORTAGE OF CARE FOR OLDER AMERICANS — There aren’t enough healthcare professionals in the country to care for the older adult population, according to an issue brief by the Eldercare Workforce Alliance, a coalition of 30 national organizations. More than a million new direct-care workers will be needed nationwide, the group’s public policy committee chairman Steve Edelstein said. The briefs: http://bit.ly/1fkcCFZ

PROVIDERS WANT EHR PROGRAM DELAYED – Forty-eight provider groups are asking Sebelius to delay requirements through 2015 for Stage 2 of the meaningful use program for electronic medical records. They’re set to take effect this fall for 5,000 hospitals and 550,000 providers, who must either meet them or face significant penalties. But only a fraction of the available electronic health record software products are certified to 2014 standards, the groups write. HHS already extended the start of Stage 3 until 2017. The letter: http://politico.pro/1hLQOel

…ICYMI: On Friday CMS released a proposed rule for its 2015 EHR certification requirements. It would require the products to contain a field for an identification number which would enable the tracking of medical devices through health records. The rule: http://1.usa.gov/1gTqhJ2

WHAT WE’RE READING, By Susan Levine:

The Wall Street Journal reviewed earnings-call transcripts and found more than 80 public companies that had told investors their quarterly earnings could be affected — in either a positive or negative direction — by the Affordable Care Act. http://on.wsj.com/1fAl5tl

Connecticut's success in getting people covered through its online marketplace got officials thinking about the technology they'd developed, and the state is now establishing its own consulting business to help other states with their own enrollment websites, the New York Times says. http://nyti.ms/1ciyguy

The Salt Lake Tribune is following an effort by Republicans in the Utah House to push forward an alternative to Medicaid expansion that would cover 54,000 poor adults in the state — despite the opposition of Republican Gov. Gary Herbert http://bit.ly/1foeN1s

The Hispanic Community Health Study/Study of Latinos — the nation's biggest and most diverse study of its kind — may help researchers understand why Hispanics live longer than whites despite higher rates of overweight, high blood pressure and diabetes, according to the Miami Herald. http://hrld.us/NsRAyW

USA Today reports on a study in JAMA Pediatrics that found a potential link between acetaminophen taken during pregnancy and attention deficit hyperactivity disorder (ADHD) in children. http://usat.ly/1mt4Obz

** The skilled nursing and assisted living profession is not a bystander in the budget debate. Our long term and post-acute care providers know that smart policies result in better care and more balanced budgets. With operating margins teetering dangerously at 1.8 percent, we know that actions must take the place of rhetoric. Our profession is offering solutions to issues that make a difference in patients’ lives and Medicare’s budget, such as reducing hospital readmissions, improving patient outcomes and increasing quality care in America’s skilled nursing and post-acute care centers. But these solutions are just the beginning. We are AHCA and NCAL. And we are the solution. Learn more at ahcancal.org/solutions.

** A message from PhRMA: Diabetes is a complex disease affecting more than 30 million Americans – with one-in-ten living in DC, Maryland and Virginia having the disease. Thanks to advances in diabetes care, patients around the country are living longer, healthier lives. Take five-year-old Rhys for example [link to his I’m Not Average profile]. He was diagnosed with type 1 diabetes at 15-months-old, but today, he is a thriving young boy. This is due in large part to new and innovative medicines developed by researchers and scientists at America’s biopharmaceutical companies. Learn more about the medicines in development for diabetes here. **

Authors:

About The Author

Paige Winfield Cunningham is a health care reporter for POLITICO Pro and co-author of the morning newsletter Pulse. Previously she reported for The Washington Times’ political team, covering elections, Congress and health policy, including the 2012 Supreme Court ruling on the Affordable Care Act.

Cunningham grew up in St. Louis and attended college in the Chicago area, graduating from Wheaton College in 2006. She spent most of her time at the Wheaton Record, where she served as features editor, but made sure she still had time for playing violin in the conservatory orchestra.

Cunningham covered county government for the Naperville Sun right out of college, but when the paper filed for bankruptcy, she decided it was time to move on. She moved to the D.C. area in 2009 to report on Virginia government and currently lives in that state with her husband.